In order to maintain eligibility, a periodic evaluation has to be made to determine
whether EOPS/CARE/MCP students are attending classes and making satisfactory progress.
To initiate an accurate assessment and take appropriate action, we ask for your
cooperation. Your feedback and/or suggestions are very important. If you find that
the student's status is not addressed by this form, please call the EOPS Department at ext. 7207.

All required fields are listed in Red

Student Information -

* Student Name:

* Student ID Number:

(8 digits, use no dashes)

Quarter:

Summer
Fall
Winter
Spring

Academic Year:

*Course name & number:

*Units:

Which Evaluation:

First
Second

Rate the student's performance using the codes and sub-codes (below).

Codes

Sub-Codes

Excellent

Recommend as tutor

Failing performance on exams

Above Average

Attending regularly/no grade yet

Recommend tutoring

Average

Irregular Class Attendance

Lacks preparation of assignments

Below Average

Refer to counselor

Must take prerequisite classes

Failing

Incomplete assignments

Other:

Comments or suggestions?

Faculty / Staff Information -

* Instructor Name:

* Your Department:

* Contact Phone:

* Contact eMail:

Form Validation -

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